http://www.helpguide.org/elder/lewy_body_disease.htm
What is Lewy Body Dementia?
Lewy bodies are abnormal microscopic protein deposits in the brain that disrupt the brain's normal functioning causing it to slowly deteriorate. The effects include a degradation of cognitive functioning, similar to Alzheimer's disease, or a degradation of motor control, similar to Parkinson's disease. Lewy bodies are named after Frederick Lewy who first observed their effects
Lewy Body Dementia can start differently in people. Sometimes those with LBD initially have a movement disorder that looks like Parkinson's but later they also develop dementia symptoms. Others have a memory disorder that looks like Alzheimer's but they later develop hallucinations and other behavior problems. Over time most people with LBD develop a spectrum of problems that include great variations in attention and alertness from day to day, recurrent visual hallucinations, shuffling gait, tremors, and blank expression, along with various sleep disorders.
Signs and symptoms of Lewy Body Dementia
The symptoms of Lewy Body Dementia will worsen over time. In general, LBD progresses at about the same rate as Alzheimer's disease, typically over several years. Many of the symptoms of the disorder bear a striking resemblance to Alzheimer's or Parkinson's. Despite the overlaps, however, there are symptoms that indicate the disorder is indeed LBD and not other dementias and the difference is important.
Signs of Lewy Body Dementia
Mental decline. Lewy Body patients may experience reduced alertness and lowered attention span.
Recurrent visual hallucinations or depression. Hallucinations, usually related to people or animals, occur in most LBD patients. Depression is also common.
Increasing problems handling the tasks of daily living. Tasks that used to be simple may become difficult for a person with Lewy Body Dementia.
Repeated falls and sleep disturbances. This includes insomnia and acting out dreams. Fluctuations in autonomic processes. This includes blood pressure, body temperature, urinary difficulties, constipation, and difficulty swallowing. Parkinson’s, Alzheimer’s and Lewy Body Dementia Since Lewy Body Dementia is commonly misdiagnosed for both Parkinson’s and Alzheimer’s, it is helpful to understand how these diseases overlap.
Some of the motor symptoms found in both Parkinson’s and Lewy Body Disease's patients include:
帕金森式症與路易式體失智症共同動作上的病態:
震顫; 顫抖(tremors )
小碎步步態(shuffling gait)
駝背的姿態 (stooped posture)
肌肉僵硬(muscle stiffness)
平衡困難(difficulties with balance)
動作緩慢(slow movements)
腿部不安症候群(restless leg syndrome)
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Some of the cognitive symptoms found in both Alzheimer's and Lewy Body's patients include:
behavioral changes
decreased judgment
confusion and temporal/spatial disorientation
difficulty following directions
decreased ability to communicate
dandruff right above eyebrows
Restless sleep or daytime fatigue
A soft voice or slurred speech
Parkinson's disease dementia, PDD:
Difficulty swallowing
Memory problems, confusion, or dementia
Oily skin and dandruff
Constipation
Rigidity occurs when the muscles stay stiff and don't relax. For example, the arms may not swing when a person is walking. There may be cramping or pain in the muscles. Most people with Parkinson's experience some rigidity.
The Hoehn and Yahr Scale is one common tool that looks at the severity of symptoms.The Unified Parkinson Disease Rating Scale evaluates mental clarity and function, behavior and mood, activities of daily living, and motor functions. Staging can help determine the best treatment. Treatment: Levodopa
Levodopa (L-dopa) is an amino acid that the brain converts into dopamine. It's been used since the 1970s and is still the most effective Parkinson's medication. It reduces bradykinesia and rigidity, helping people to move more easily. Eventually, levodopa may wear off quickly. It should not be taken with a high-protein diet. Common side effects are nausea, vomiting, and drowsiness. Hallucinations, paranoia and involuntary movements (dyskinesias) may occur with long-term use.
Dopamine Agonists
Drugs that mimic dopamine, called dopamine agonists, may be used to delay the movement-related symptoms of Parkinson's. They include Apokyn, Mirapex, Parlodel, and Requip. Apokyn, an injectable, may be used when the effects of levodopa begin to wear off. Side effects may include nausea and vomiting, drowsiness, fluid retention, and psychosis.
Comtan and Tasmar can improve the effectiveness of levodopa, with a possible side effect of diarrhea. Patients on Tasmar need regular monitoring of their liver function. Stalevo combines levodopa, carbidopa, and entacapone (the drug in Comtan).
Azilect, Eldepryl, and Zelapar, which inhibit the breakdown of dopamine, may be prescribed early in the disease or used along with levodopa. They should not be used with certain antidepressants.
Surgery: Deep Brain Stimulation
Electrodes can be implanted into one of three areas of the brain -- the globus pallidus, the thalamus, or the subthalamic nucleus -- on one or both sides. A pulse generator goes in the chest near the collarbone. Electric pulses stimulate the brain to help reduce a patient's rigidity, tremors, and bradykinesia. It doesn’t stop the progression of PD or affect other symptoms. Not everyone is a good candidate for this surgery.
Surgery: Pallidotomy and Thalamotomy
These surgical procedures use radio-frequency energy to permanently destroy a pea-sized area in the globus pallidus or the thalamus. These areas are associated with tremor, rigidity, and bradykinesia, so movement generally improves after surgery with less reliance on levodopa. However, because these surgeries are irreversible, they have become less common than deep brain stimulation.
Dysphagia is the medical term for the symptom of difficulty in swallowing
路易氏體相關失智症（Lewy body-related dementias）包括了巴金森氏症失智症（Parkinson's disease dementia, PDD），以及失智症合併路易氏體（dementia with Lewy bodies, DLB），是除了阿滋海默氏症（Alzheimer's disease, AD）以外，最為常見的失智症候群。臨床表現除了智能退化，還合併了動作障礙，治療上選擇不多且相當困難。對於智能的退化，先前的研究顯示rivastigmine對於PDD以及DLB能夠提供症狀上的改善。汲取自治療AD的經驗，memantine可能在這類疾病的治療可能有效，而這篇雙盲、安慰劑控制、多中心的臨床試驗證實了這個想法，雖然研究的規模不大，但已為這樣的患者帶來治療的一線曙光。（臨床醫學 2009; 64: 387-8）
關鍵詞：
巴金森氏症失智症（Parkinson's disease dementia, PDD）、失智症合併路易氏體（dementia with Lewy bodies, DLB）、memantine
http://homepage.vghtpe.gov.tw/~clinmed/abst98/abst9811p387.htm
BPSD (Behaviorial and Psychological Sympatons of Dementia): 憂鬱妄想認錯幻覺
長庚家醫科:張可臻, 陳昭源, 林忠順
http://www.tafm.org.tw/Data/011/526/230602.pdf
Dementia with Lewy bodies (DLB)
DLB is a brain disease that causes progressive changes with movement or thinking. In DLB, abnormal structures called Lewy bodies form in certain areas of the brain. Sometimes the symptoms of DLB resemble those of Parkinson’s disease-such as a shuffling gait, tremor, and problems with movement. In other cases, symptoms of DLB (such as confusion and memory loss) may mimic the symptoms of Alzheimer’s disease. Often a combination of both Parkinson’s and Alzheimer’s symptoms appear together. These symptoms may occur in DLB because the structures in the brain affected by DLB are similar to those affected by Parkinson’s disease or Alzheimer’s disease. Some experts think that DLB may be a form of Parkinson’s disease or Alzheimer’s disease.
The progression of DLB is slow. Although there is no cure for DLB, treatment is available to reduce symptoms of the disease.
http://www.webmd.com/parkinsons-disease/tc/parkinson-plus-syndromes-topic-overview?page=2
Progressive Supranuclear Palsy
Important
It is possible that the main title of the report Progressive Supranuclear Palsy is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.
Synonyms
PSP
nuchal dystonia dementia syndrome
Steele-Richardson-Olszewski syndrome
Disorder Subdivisions
None
General Discussion
Progressive supranuclear palsy (PSP) is a rare degenerative neurological disorder characterized by loss of balance and impaired walking; loss of control of voluntary eye movement, especially in the downward direction; abnormal muscle tone (rigidity); speech difficulties (dysarthria); and problems related to swallowing and eating (dysphagia). Affected individuals frequently experience personality changes and cognitive impairment. Symptoms typically begin after age 60 but can begin earlier. The exact cause of progressive supranuclear palsy is unknown. PSP is often misdiagnosed as Parkinson disease, Alzheimer disease, or other neurodegenerative disorders.
Resources
WE MOVE (Worldwide Education and Awareness for Movement Disorders)
5731 Mosholu Avenue
Bronx, NY 10471
USA
Tel: (347)843-6132
Fax: (718)601-5112
Email:
[email protected] Internet: http://www.wemove.org
CurePSP: Foundation for PSP l CBD & Related Brain Diseases
30 E. Padonia Road, Suite 201
Timonium, MD 21093
Tel: (410)785-7004
Fax: (410)785-7009
Tel: (800)457-4777
Email:
[email protected] Internet: http://www.curepsp.org
